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Conaway, Benson, Pinkin & Wimberly Bill Requiring Health Insurers to Cover New Abuse-Deterrent Pain Medications Continues to Advance

Legislation is Aimed at Reducing Opiate Addictions & Overdoses

Legislation sponsored by Assemblymen Herb Conaway, Jr., M.D., Daniel Benson, Nancy Pinkin and Benjie Wimberly requiring health insurers to cover prescription pain relief medications designed to decrease abuse and addiction advanced in the legislature on Monday with the approval of the Senate Commerce Committee.

Specifically, the bill (A-4271) would require health insurers to provide health benefits coverage for prescribed abuse-deterrent opioid analgesic drugs.

“As it stands now, deaths from opioid addiction are at epidemic proportions,” said Conaway (D-Burlington), a practicing physician. “Pain treatment, similar to other courses of treatment, can have side effects – including the risk of addiction. As a doctor, my goal is to reduce those risks and make the patient well. Removing the cost barrier to abuse-deterrent opiates will increase the prescribing and use of these high-tech drugs, which have significant potential to reduce dependency and overdoses. We as policymakers should be encouraging the widespread use of abuse-deterrent formulations to protect consumers and lower costs to the health care system. That’s exactly what this bill achieves.”

Abuse-deterrent opioid analgesic drugs are pain medications approved by the U.S. Food and Drug Administration to significantly reduce abuse by making them resistant to crushing, breaking or dissolution so that they cannot be snorted or injected for a quick high–reinforcing the extended-release deterrent mechanism.

“Far too many young people are attracted to the quick high opiates can produce. There are also too many people who have taken opiates at the advice of their doctor for legitimate pain management, only too find themselves unwittingly dependent on them,” said Benson (D-Mercer/Middlesex). “If there’s a safer, less addictive alternative for pain management, we should be supporting and promoting it.”

The sponsors noted that following the introduction of abuse-deterrent extended-release oxycodone in 2010, dispensing of prescription opioid pain medication and prescription opioid overdoses both dropped by nearly 20 percent two years after this change according to an April study published in the Journal of the American Medical Association.

Under the bill, the following insurers – health, hospital and medical service corporations; commercial individual and group health insurers; health maintenance organizations; health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs; the State Health Benefits Program; and the School Employees’ Health Benefits Program) – would be required to provide coverage subject to the following requirements:

1) If the health insurer provides prescription drug benefits through use of a formulary, all abuse-deterrent opioid analgesic drugs shall be on the most preferred tier of the formulary;
2) Cost-sharing for abuse-deterrent opioid analgesic drugs shall not exceed the lowest cost-sharing level applied to other prescription drugs; and
3) Any prior authorization requirements or other utilization review measures for opioid analgesic drugs shall not require first use of non-abuse-deterrent opioid analgesic drugs in order to access opioid analgesic drugs with abuse-deterrent properties.

“Prescription painkiller abuse continues to be a major problem in our communities,” said Pinkin (D-Middlesex). “Anything that can possible be done to slow the rampant abuse of prescription narcotics should be done. This bill is a good start.”

“Drug addiction is an illness which many in New Jersey are battling,” said Wimberly (D-Bergen, Passaic). “This legislation is not a cure all for prescription drug abuse. However, this is a step in the right direction. One aimed at helping individuals who are suffering to curb their addiction.”

The measure was approved by the Assembly Health and Senior Services Committee chaired by Conaway on June 1. The full Assembly approved the bill on June 30, 60-13-5. It is now poised for further consideration by the full Senate.